Provider Demographics
NPI:1114788767
Name:DAVIS-MARENCO, NICOLE RENEE (FNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:DAVIS-MARENCO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:RENEE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7777 N INGRAM AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-6281
Mailing Address - Country:US
Mailing Address - Phone:559-472-7546
Mailing Address - Fax:559-412-7266
Practice Address - Street 1:7777 N INGRAM AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-6281
Practice Address - Country:US
Practice Address - Phone:559-472-7546
Practice Address - Fax:559-412-7266
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner